Provider Demographics
NPI:1467289975
Name:OWEN, AUDREY ROSE (SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROSE
Last Name:OWEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ROSE
Other - Last Name:WALTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:705 RILEY HOSPITAL DR STE 0860
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-944-8868
Mailing Address - Fax:
Practice Address - Street 1:1002 WISHARD BLVD STE 2021
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4164
Practice Address - Country:US
Practice Address - Phone:317-944-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007401A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist